Lichenoid lymphomatoid keratosis

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Dense Inflamatory Cell Infiltrate
Fig. 20.8 Solitary T-cell pseudolymphoma. Dense band-like infiltrate in the upper dermis.

tion; see p. 165). They represent distinct entities, which have been referred to as 'solitary T-cell pseudolymphoma' in the literature [36,37]. These lesions are frequently located on the breasts of adult women (Fig. 20.7). Histology reveals a band-like infiltrate in an expanded papillary dermis, sometimes with exocytosis of lymphocytes within the epidermis (Figs 20.8 & 20.9). In several patients, a monoclonal rearrangement of the TCR genes has been reported. Some of the cases reported in the past as 'unilesional' or 'solitary' mycosis fungoides may represent examples of solitary T-cell pseu-dolymphoma but at present it is not possible to establish with certainty whether they are wholly benign monoclonal lymphoid proliferations or represent a variant of cutaneous T-cell lymphoma with a very favourable course [38]. Surgical excision results in complete remission; recurrences are uncommon.

There may be some overlap between solitary T-cell pseu-dolymphoma and so-called lichenoid keratosis (see below).

Lichenoid (lymphomatoid) keratosis is a benign epithelial neoplasm, related in some cases to seborrhoeic keratosis and lentigo actinica (Fig. 20.10) [39,40]. Patients are elderly adults with small scaly plaques located usually on the trunk. The histopathological features with dense band-like inflammatory lymphoid infiltrates and often epidermotropism of lymphocytes may be indistinguishable from those of mycosis fungoides (Fig. 20.11) [41]. Moreover, clonality of T lymphocytes can sometimes be found in these lesions. Accurate clinicopathological correlation is crucial to establish a correct diagnosis.

Differentiation of lichenoid (lymphomatoid) keratosis from solitary T-cell pseudolymphoma may be impossible in cases that do not show clear-cut features of an epithelial neoplasm, and the two conditions may be strictly related (see above).

Scaly Lesion Skin
Fig. 20.10 Lichenoid (lymphomatoid) keratosis. Small scaly plaque on the breast.
Lymphomatoid Contact Dermatitis
Fig. 20.11 Lichenoid (lymphomatoid) keratosis. Band-like infiltrate of lymphocytes with exocytosis in the lower layers of the epidermis.

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